Provider Demographics
NPI:1952910804
Name:JEAN-LOUIS, PATRICK (COTA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13837 SHEFFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7643
Mailing Address - Country:US
Mailing Address - Phone:561-275-4886
Mailing Address - Fax:
Practice Address - Street 1:3060 MELALEUCA LN
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-5174
Practice Address - Country:US
Practice Address - Phone:561-357-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA17808224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant